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J frUKUFFIC.t USE: --------------------- ---------' /A.G _. A30_ - APPLICATION FOR SANITATION PERMIT Permit No. _:-t 6 -- ---- -- --- _.fl' :� i (Complete in Duplicate) This Permit Ex ires 1 Year From Date Issued Date Issued _aj/ G.41 .. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549.or !OB ADDRESS AND LOCATION___ �-T.--------------------------------------------- ---------------- -------------------- ---------------------- • -------------------------- G)wner s Name--- SLS 5 z / II ----------------- - --------------------- ------ Phone.._ _. ---d ----5 If Address ` --'�----1-------�------------------�---------------------�� Contractors Name •--- ------------------ _ -----. Phone----------------..._ --------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ : Number of living units: 1-___ Num14r of bedrooms T-_ Number of baths J_._. Lot size __i Q 'Z d---------------------------- Water -------- --Water Supply: Public system0 Community system [:1 Private [] Depth to Water Table ____fit. ,l. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E❑ Adobe Hardpan ❑ P�evious Application Made: 1 (If yes,date---,-xCP._....I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SIe ptic Tank: Distance`from nearest well-----------------Distance from foundation___-----------------Material____________-__ No. of compartments------- ------------------Size--------------------------------'Liquid depth------------- ----- CaP--city --------- lspos Field: Distance from nearest well________________Distance from foundation_____.-___-_________Distance to nearest lot line______--.__-__--- II� `{ Number of lines-----------------------------------Length of each line------------------------------Width of trench ----------------•------------_----- i: Type of filter material________________________Depth of filter material___-_____-___--_.--___Total length___________-__--_---________ -------------- Seepage Pit: Distance'to nearest well ...f'49v--------Distance from foundation----- d ____.Distance to nearest lot line__ ❑ Dumber'of pits------/--------------Lining material--. ---..Size: Diameter--Y-Y- ------------_--_Depth------3_7� ----- C:esspool: Distance from nearest well-----------------Distance from foundation----------------- mat4101- ---------------------------------- J i `i ❑ Size: DiameterDepth Liquid ac-- ----------------- city --------------------- --gals. Prlivy: Distance'from nearest well-------------------______________---------------Distance from nearest building-_-__-__---_______________.__-_--:-------- 11i ❑' Distance to nearest lot line_________________:-___-__._____._ - ------------------------- Remodeling and/or repairing (describe):- --------- ---------------------------------------------- � __ ______________ _ -- - __M -•-•- x t--- ----------------- ---------------------------------------•--- --- I hereby certify that I hhve prepared this application and that the work will be done in accordance with San Joaquin County o dinances, State laws, and rules and regulations of the San Joaquin Local Health District. I� (SIgned)-----------------------------•-------I------------- ---- --------------------- ---------------------------------------------- -------------------------------------(Owner and/or Contractor) BY -------------------•-••---------------------•------ Tltle -- -------- - - ----------------------------------- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ��. FOR DEPARTMENT USE ONLY �r APPLICATION ACCEPTED BY -------- DATE_..S-.5 BUILDING PERMIT ISSUED------------ -- -----------•-------------------------------- ----- DATE_ IEWED BY -- ATE r Altera#ions and/or recommendations: -` -`--�d----- `-- ----•----- -------- --- -- ---- --------------------------------------------------------------------------------------- ----- ---------------------- ---------- ----------- ----- - ---------------- ---------------------- - ------ ii ----------- -------- --------------------------------- ------- FINAL INSPECTION BY:. .......... ----- - Date------ -------- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California / \ F.P.CO.